<!--
 * @Author: Wulala
 * @Date: 2025-04-15 15:08:35
 * @LastEditTime: 2025-04-22 16:51:47
 * @LastEditors: Wulala
 * @Description: 
 * @FilePath: \exchange\app\admin\view\mall\order_cash\send.html
 * 可以输入预定的版权声明、个性签名、空行等
-->
<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
    
        <input type="hidden" name="status" class="layui-input" value="1">
       
        <div class="layui-form-item">
            <label class="layui-form-label required">转账单号</label>
            <div class="layui-input-block">
                <input type="text" name="pay_num" class="layui-input" style="color: #696868;" lay-verify="required"  placeholder="请输入转账单号" value="{$row.pay_num|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">备注</label>
            <div class="layui-input-block">
                <input type="text" name="send_remark" class="layui-input"  placeholder="请输入备注" value="{$row.send_remark|default=''}">
            </div>
        </div>
        
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <input type="checkbox" name="if_confirm" lay-skin="primary" title="已确认单笔限额" value="1">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
        </div>
    </form>
</div>